Gastrostomy is the creation of a temporary or permanent feeding tract between the stomach and the skin of the upper abdominal wall. It is used primarily to permit direct feeding for patients who cannot accept food orally. For example, gastrostomy is frequently required for patients unable to swallow as a result of central nervous system impairment resulting from any of a variety of causes.
Currently, gastrostomies are usually performed by endoscopic placement of a feeding tube in which a wire is passed into the stomach through the abdominal wall and the wire retrieved with an orally introduced endoscope. A feeding tube is secured to the wire and then pulled down the esophagus into the stomach and out through the abdominal wall. A retention dome on the distal end of the feeding tube retains the tube within the patient's stomach. This procedure is known as percutaneous endoscopic gastrostomy (PEG).
Intravenous or nasogastric feeding is typically indicated for short term feeding needs (e.g. post surgical patients), but percutaneous gastrostomy is the procedure of choice when long duration feeding requirements are anticipated. However, there are certain problems associated with long term use of a PEG feeding tube, the primary one being the inevitable deterioration of the tube over time. Even silicone feeding tubes eventually require removal and replacement. Moreover, the extension of the feeding tube externally of the gastrostomy site (stoma) may lead to inadvertent removal, leakage or adverse psychological consequences.
Because of these problems, various replacement feeding tubes have been proposed for introduction into an existing stoma site without the need to perform an additional endoscopic procedure. One such device is shown in Gauderer U.S. Pat. No. 4,863,438. This and other replacement devices have proven to be useful products in that (a) they are low profile, i.e. essentially flush with the skin thus avoiding problems associated with extended length feeding tubes, and (b) include one-way valves which prevent backflow of gastric contents (reflux). Nevertheless, despite the usefulness of such replacement products, it is necessary to first place a standard PEG tube and then remove the tube and insert the replacement device. Moreover, the length of the replacement device is likely to vary from patient to patient; therefore, hospitals must maintain an inventory of different sizes since the available replacement devices are not adjustable in size.
It would therefore be advantageous for both patient and physician to be able to convert a previously placed PEG feeding tube into a skin level feeding device having all the advantages of the currently available replacement devices and eliminating the need to remove the initially placed feeding tube and insert a replacement device.
A device which seeks to achieve the foregoing objective is disclosed in Cohen, O. M., et al.: Skin Level Permanent Feeding Gastrostomy, AM.J.Surg 141:391, 1981. This article discloses a feeding tube, inserted into the stomach through the abdominal wall, which is cut at skin level. A stainless steel hub is fitted tightly into the tube over a teflon plate, and a feeding adaptor screwed into the hub when the patient is to be fed. Between meals, the feeding adaptor is removed and the hub closed with a locking screw.
The object of this invention is to provide an improved device for adapting an endoscopically inserted gastrostomy tube for long term feeding procedures.
A more specific object of the invention is to provide an adaptor of the type described which is easier to insert and simpler to use during the feeding process than the Cohen et al. device.
A further object of the invention is to provide an improved adaptor for an endoscopically inserted gastrostomy tube which is also usable with a replacement device, thereby enabling the surgeon to adjust the length of a replacement device for individual patients.